Abstract Body (Do not enter title and authors here): Context: Atrial fibrillation (AF) and congestive heart failure (CHF) commonly coexist in older adults, significantly increasing morbidity and mortality. However, long-term trends in AF-related mortality among CHF patients remain inadequately characterized.
Objective: To evaluate national trends in AF-related mortality among adults aged ≥55 years with CHF in the United States from 1999 to 2023.
Methodology: Death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC Wonder) database were examined from 1999 to 2023 for multiple causes of death, MCD-ICD 10 Code (I48 and I50.0). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated for older adults (age 55+) and stratified by ten-year age group, gender, race/ethnicity, and census region
Results: A total of 325,385 AF-related deaths in CHF patients aged ≥55 years were identified from 1999 to 2023. Overall mortality increased during the study period, with an APC of 2.35% (95% CI: 2.11 to 2.62). From 1999 to 2011, mortality rose with an APC of 1.78% (95% CI: 0.99 to 2.35); followed by a sharper increase from 2011 to 2021 (APC: 3.75%, 95% CI: 3.25 to 5.83), and a decline occurred between 2021 and 2023 (APC: -1.10%, 95% CI: -3.50 to 2.62). The overall AAMR in 2023 was 62.72 per 100,000.
Sex-stratified analysis showed that for females, the APC from 1999 to 2023 was 2.15% (95% CI: 1.91 to 2.43), with a 2023 AAMR of 54.24. Among males, mortality trends varied by period: 1999–2009 APC was 2.00% (95% CI: -0.31 to 2.83), 2009–2018 APC was 3.81% (95% CI: 2.13 to 4.45), 2018–2021 APC was 6.57% (95% CI: 4.62 to 7.80), and 2021–2023 APC was -3.07% (95% CI: -5.19 to -0.38). The AAMR for males in 2023 was 74.01.
Regional analysis in 2023 revealed the highest AAMRs in the Midwest (69.08) and West (65.78), followed by the South (62.17), and Northeast (52.59). Racial analysis showed AAMRs of 71.54 in White individuals, 42.19 in African Americans, 32.44 in Hispanics, and 40.69 in Alaska Natives in 2023.
Conclusion: Atrial fibrillation-related mortality in CHF patients aged ≥55 years has risen significantly over the past two decades, with pronounced disparities by sex, race, and region. The recent plateau may reflect evolving clinical practices, but persistent gaps—particularly among males and White populations—highlight the need for targeted, equity-driven cardiovascular care strategies.